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Intravenous Lidocaine versus Morphine Sulfate in Pain Management for Extremity Fractures; a Clinical Trial

Arash Forouzan, Hassan Barzegari, Hassan Motamed, Ali Khavanin, Hamideh Shiri
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Abstract

Introduction: Considering the existing contradictions regarding effectiveness of intravenous (IV) lidocaine, especially in emergency department (ED), the present study was designed to compare the analgesic effect of IV lidocaine and morphine sulfate in pain management for extremity bone fractures. Method: In this triple blind clinical trial, 15 to 65 year-old patients with extremity fractures and in need of pain management were randomly allocated to either IV lidocaine or morphine sulfate group and were compared regarding severity of pain 5, 10, 15, 20, 25, and 30 minutes after infusion via intention to treat analysis.  The absolute risk reduction, number needed to treat and relative risk of IV lidocaine after 30 minutes were 0.40 (95%CI: 0.25 – 0.64), 7 (95%CI: 3.7 – 23.1), and 20.71 (95%CI: 10.91 – 30.51), respectively. Results: 280 patients with the mean age of 32.50 ± 12.77 years were randomly divided into 2 equal groups of 140 (73.9% male). The 2 groups had similar baseline characteristics. 15 minutes after injection success rate was 49.28% in lidocaine and 33.57% in morphine sulfate group (p = 0.011), and after 30 minutes it reached 85.71% and 65.00%, respectively (p < 0.001). Conclusion: Based on the results of the present study, IV lidocaine could be considered as a reasonable alternative choice for pain management in ED. 


Keywords

Lidocaine; morphine; pain management; emergency service, hospital; fractures, bone

References

Wu CL, Raja SN. Treatment of acute postoperative pain. The Lancet. 2011;377(9784):2215-25.

Koppert W, Weigand M, Neumann F, Sittl R, Schuettler J, Schmelz M, et al. Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesthesia & Analgesia. 2004;98(4):1050-5.

McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery. Drugs. 2010;70(9):1149-63.

Joris J, Kaba A, Lamy M. Transition between anesthesia and post-operative analgesia: relevance of intra-operative administration of analgesics. Acta anaesthesiologica Belgica. 2000;52(3):271-9.

Choi SJ, Kim MH, Jeong HY, Lee JJ. Effect of intraoperative lidocaine on anesthetic consumption, and bowel function, pain intensity, analgesic consumption and hospital stay after breast surgery. Korean journal of anesthesiology. 2012;62(5):429-34.

Grady P, Clark N, Lenahan J, Oudekerk C, Hawkins R, Nezat G, et al. Effect of intraoperative intravenous lidocaine on postoperative pain and return of bowel function after laparoscopic abdominal gynecologic procedures. AANA journal. 2012;80(4).

Gordon D, FAAN M, Schroeder M. Intravenous lidocaine for postoperative analgesia: renewed interest in an old strategy. Am Pain Soc Bull. 2008;18:3-5.

Cepeda MS, Delgado M, Ponce M, Cruz CA, Carr DB. Equivalent outcomes during postoperative patient-controlled intravenous analgesia with lidocaine plus morphine versus morphine alone. Anesthesia & Analgesia. 1996;83(1):102-6.

Kaba A, Laurent SR, Detroz BJ, Sessler DI, Durieux ME, Lamy ML, et al. Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. The Journal of the American Society of Anesthesiologists. 2007;106(1):11-8.

McKay A, Gottschalk A, Ploppa A, Durieux ME, Groves DS. Systemic lidocaine decreased the perioperative opioid analgesic requirements but failed to reduce discharge time after ambulatory surgery. Anesthesia & Analgesia. 2009;109(6):1805-8.

Martin F, Cherif K, Gentili ME, Enel D, Abe E, Alvarez JC, et al. Lack of impact of intravenous lidocaine on analgesia, functional recovery, and nociceptive pain threshold after total hip arthroplasty. The Journal of the American Society of Anesthesiologists. 2008;109(1):118-23.

Wasiak J, Mahar P, McGuinness SK, Spinks A, Danilla S, Cleland H. Intravenous lidocaine for the treatment of background or procedural burn pain. The Cochrane Library. 2012.

Farag E, Ghobrial M, Sessler DI, Dalton JE, Liu J, Lee JH, et al. Effect of perioperative intravenous lidocaine administration on pain, opioid consumption, and quality of life after complex spine surgery. The Journal of the American Society of Anesthesiologists. 2013;119(4):932-40.

Beaudoin FL, Haran JP, Liebmann O. A Comparison of Ultrasound‐guided Three‐in‐one Femoral Nerve Block Versus Parenteral Opioids Alone for Analgesia in Emergency Department Patients With Hip Fractures: A Randomized Controlled Trial. Academic Emergency Medicine. 2013;20(6):584-91.

Sahota O, Rowlands M, Bradley J, Van de Walt G, Bedforth N, Armstrong S, et al. Femoral nerve block Intervention in Neck of Femur fracture (FINOF): study protocol for a randomized controlled trial. Trials. 2014;15(1):189.

Insler SR, O'Connor M, Samonte AF, Bazaral MG. Lidocaine and the inhibition of postoperative pain in coronary artery bypass patients. Journal of cardiothoracic and vascular anesthesia. 1995;9(5):541-6.

Striebel H, Klettke U. Is intravenous lidocaine infusion suitable for postoperative pain management? Schmerz (Berlin, Germany). 1992;6(4):245-50.

Juliano PJ, Mazur JM, Cummings RJ, McCluskey WP. Low-dose lidocaine intravenous regional anesthesia for forearm fractures in children. Journal of pediatric orthopedics. 1992;12(5):633-5.

El-Tahan MR, Warda OM, Diab DG, Ramzy EA, Matter MK. A randomized study of the effects of perioperative i.v. lidocaine on hemodynamic and hormonal responses for cesarean section. Journal of anesthesia. 2009;23(2):215-21.

Yardeni IZ, Beilin B, Mayburd E, Levinson Y, Bessler H. The effect of perioperative intravenous lidocaine on postoperative pain and immune function. Anesthesia and analgesia. 2009;109(5):1464-9.

Koppert W, Weigand M, Neumann F, Sittl R, Schuettler J, Schmelz M, et al. Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesthesia and analgesia. 2004;98(4):1050-5, table of contents.




DOI: http://dx.doi.org/10.22037/emergency.v5i1.17269

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